MANILA – After a House resolution was passed last month urging President Benigno Aquino III to halt the “exploitative practice of collecting training fees from professional and registered nurses under various forms of ‘volunteer training programs’ by public and private hospitals”, hospitals reportedly got alarmed. “They stopped for a while, but now they’re coming back with different methods of ‘volunteer training for a fee’”, said nurse Leah Paquiz, president of an organization of nurses called Ang Nars.
Some hospitals have also retaliated against young nurses who exposed the volunteer/training-for-a-fee scheme.
“Forty-six of us nurses who had paid the hospital for our ‘training’ were dismissed when we made it known to the country that we are ‘volunteers’. It’s very wrong but nurses can’t speak out for fear of being blacklisted,” said Philip So Chan. Chan has a visa and could have opted to work abroad but he chose to remain in the country to “develop health care here.” His noble intention was repaid by being forced to swalow the volunteer-for-a fee scheme so that he could gain work experience to qualify for a full-time regular nursing job.
Under the guise of specialty training, some hospitals today have continued the “volunteer for a fee training scheme,” which has been happening in the Philippines for more than a decade now. This highly irregular scheme was exposed only recently and is being opposed more strongly and openly by nurses’ groups with the support of progressive lawmakers.
This so-called volunteerism has “prostituted” the concept of bayanihan or voluntary cooperation as a Filipino tradition, said Dr Teresita I. Barcelo, president of the Philippine Nurses Association. Under the detested scheme, nurses who have already been trained and licensed are still being forced to submit to another layer of “training” in hospitals.
It is a very “clear unfair labor practice on two grounds”, said Barcelo. One, registered and licensed nurses already have “the necessary skills and knowledge to perform regular nursing functions in the hospital.” As such, undergoing a ‘volunteer for a fee’ as training is “not a prerequisite for hiring.” Two, Barcelo said, registered nurses doing volunteer work concretely augment the deficit of nursing staff in many hospitals where the standard 1 : 10 nurse-patient ratio is not being met.
Public and private hospitals are reportedly making a killing through the scheme, because they are reaping profits and they do not have to hire the required number of regular or permanent nurses. They are taking advantage, instead, of the newly licensed nursing graduates who not only work for them without salaries and hazard benefits, but even pay certain amount of fees.
The fees can cost from P1,000 ($23.11) to P10,000 ($231) per month, for a one-month to three-months “training.” No Surplus Nurses, Only Exploited Nurses
“Too many nurses are suffering today,” said Paquiz. “All over the country, major stakeholders are private hospitals – they don’t open new positions. (They) Do not hire regular workers. Nurses could not oppose this arrangement. Often they have no choice but to submit themselves to this arrangement. From three months to three years, they work as ‘volunteers’ but they are still not absorbed as regular nurses in hospitals”.
“If you take the proper nurse to patient ratio in this country,” Paquiz said, “more than 364,000 nurses are actually needed, meaning the more than 200,000 unemployed nurses can easily be absorbed.”
All over the country, the services of nurses is needed especially in community hospitals and rural health clinics, but owing to the volunteer-for-a-fee practice of private health facilities, compounded by the low government budget for health, which had also meant reducing rather than increasing the number of employed nurses, the Philippines finds itself today “in a situation where it seemingly has surplus nurses but it also has a pressing need for their services”, said the group Nars ng Bayan.
Following the progressive partylist representatives’ series of house resolutions against the practice, Rep Edgar S. San Luis filed House Bill 767, seeking to penalize all hospitals, both public and private, which demand payment from graduate nurses in exchange for actual nursing experience gained while working in a particular hospital.
Rep Philip Pichay, also the chairman of the committee on health, promised the nurses that he would support this bill, because, he said, “For as long as we don’t remove those volunteers, the hospitals will always take advantage of them. There will always be unemployed nurses. If you’re going to still have that, and you’ll implement SSL-3, the government will lose out. It’s not as if the nurses are really being trained…. They’re being treated worse than a servant, and yet they’re the ones paying the hospital, I find that revolting,” said Pichay during the roundtable discussion with Gabriela and nurses.Deterioration of Healthcare System, Nurses’ Working Conditions
If hospitals can find ways to save on wages and even earn from nurses, it can also find ways to scrimp on the labor cost of the regular or permanent health personnel they have. There is now also a “phenomenon of outsourcing” in the nursing profession in the country where hospitals employ lower-paid “agency hired nurses,” said Jocelyn Andamo, a registered nurse who had worked as community nurse since she graduated in 1993.
As a community nurse, Andamo said she and her fellow nurses from Nars ng Bayan (Association of Community Health Workers and People’s health Advocates) have seen first-hand the vicious cycle of poverty and ill-health and the need for nurses in many underserved communities.
“While there are thousands of qualified nurses, the irony is that many poor sectors and communities especially those in remote areas continue to be underserved and deprived of even basic health care services,” said Eleanor M. Nolasco, president of Nars ng Bayan, in a statement. The group disputed the claims of labor department secretary Rosalinda Baldoz that plantilla positions for nurses in the public health system are already filled up.
“The fact remains that there is an acute need for more nurses and other health professionals to serve in the communities and in public hospitals that are generally ill-equipped and seriously understaffed,” said Nolasco.
The nurses’ group urged Health Secretary Enrique Ona to ban outright this “illegal, unethical, and exploitative practice of ‘volunteerism for a fee’ and at the same time, to provide employment opportunities for nurses with corresponding professional development and advancement programs.”
The nurses’ groups criticized as mere stop-gap the government’s various short-term, low-paying programs supposedly to ease the nursing unemployment problem. These programs include the RN HEALS, which like its predecessor, NARS or Nurses Assigned to Rural Service, “falls short of compensation for the nurses who are expected to do critical development work and provide quality nursing care in a community setting,” said Andamo of Nars ng Bayan.
Most nurses groups are united in saying that the government should adequately increase the national health budget to ensure quality health care at the same time ensuring the just compensation for nurses and other health workers.

For Filipino nurses and nursing students, the promise of a better future is hinged on the perceived huge demand for nurses abroad. As of late, however, it appears that this no longer holds true.

The foreign markets' demand for Filipino nurses remained strong up until the middle of the last decade.

The Philippine Nurses Association, Inc. (PNA) has noted that the demand from top destinations such as the US and the UK already plateaued in 2006 when quotas for visas in the US had already been filled up.

Data from the Philippine Overseas Employment Administration (POEA) showed that about 34,000 nurses were deployed abroad from 1995 to 2001. In 2001 alone the country sent nearly 14,000 nurses to 131 countries.

More recently, in 2009, the number of nurses sent abroad grew by only 6.7% to 13,456 from the previous year. This was much lower than the 40% increase from 9,004 in 2007 to 12,618 in 2008. The decline was attributed to the global economic slowdown -- a sign of the market's susceptibility to external shocks.

Still, Philippines continues to produce more nurses than the domestic and global economies can absorb.

Unofficial estimates now place the oversupply of Filipino nurses at around 150,000 as of 2008. The PNA earlier noted that as many as 1,500 qualified nurses were waiting to be employed by major hospitals in 2008. The waiting period for employment ranges from six to 12 months.

Observers cited the rapid increase in the number of nursing schools in the country for the glut. Blogger and nursing researcher Jessie Simbulan reported that there were 460 accredited nursing schools in the country in 2008.

Of particular concern, too, is the proliferation of schools offering Licensed Practical Nursing (LPN) programs, a two-year non-degree course that focuses only on the basics of nursing.

This, despite the apparent preference by foreign employers for graduates of the four-year college-degree nursing course over the two-year program.

There are a number of ways to address the glut, but many proposals revolve around ensuring the quality of the nursing curriculum to produce qualified graduates. To do this, there is a need to close down under and non-performing nursing schools.

The Commission on Higher Education has identified 112 non-performing schools out of the over 400 nursing schools in the country. It is said that only less than 20% of their graduates are passing the nursing board exams.

The PNA has already asked the Commission on Higher Education to put a stop to the proliferation of underperforming schools and move to establish new or improve the quality of the existing Licensed Practical Nursing (LPN) programs.

Despite these efforts, the glut of Filipino nurses is expected to persist. Recent reports put the number of new nursing graduates this year at 40,000, most of whom will likely join the ranks of the underemployed and unemployed.

With this, it seems that the nursing program is no longer a reliable option to exit out of poverty.

The Institute for Development and Econometric Analysis, Inc. (IDEA) is an economic think-tank based in the University of the Philippines - Diliman. For inquiries on IDEA, please contact Eduard Robleza at edjrobleza@idea.org.ph

Of the 4,500 Filipinos in the northern part of Japan, 48 remain unaccounted for according to the Website of the Philippine Embassy in Tokyo, following the 9-magnitude earthquake that flattened the northeast area of Honshu Island on 11 March.
Among the missing is a five-month-old, in a report by Malaya.
The 124 Filipino nurses and 249 caregivers in the Tohoku area were reported to be safe, the Philippine Overseas and Employment Administration said.
The Embassy may be reached through their 24-hour hotline numbers (03)5562-1570, (03)5562-1577 and (03)5562-1590 or through email: emergency@philembassy.net.
There had been no reported fatalities to this time, said the report.
According to emissary Manolo Manuel Lopez, the Embassy is waiving the processing fees for Filipinos in the four prefectures that were heavily hit by the disaster: Fukushima, Ibaraki, Iwate and Miyagi in a report by ABS-CBN.
Lopez added that the government could not shoulder the travel expenses of Filipinos who want to return from Tokyo to Manila.
Earlier today, the ANC reported that the Embassy has waived overseas employment certificate fee, which means overseas Filipino workers will not have to pay travel tax and terminal fee.
It was also reported that some foreign governments have advised their citizens within the 80-kilometer radius of the Fukushima Dai-Ichi to evacuate the area.
An additional two more buses will be deployed today to fetch more Philippine nationals from Fukushima to Tokyo. This will reach out to between 100 and 120 people.
Six Filipino sailors returned to Manila from the devastated country.
Meanwhile, Presidential Spokesman Edwin Lacierda said on 16 March that pending Tokyo's confirmation, the country will be sending a C-130 plane to the disaster-hit country to bring relief goods like water and noodles. Noodles?
"For those who would want to leave Japan but has no means, the C-130 could be used to bring them home," Lacierda said.
The plane is expected to land at the Narita International Airport and will wait for Filipinos who want to be repatriated although there is no schedule yet.
Japan is currently at Alert Level 2, which means that the state is allowing for voluntary repatriation.
If the alert were raised to the highest, which is 3, the repatriation becomes the government's responsibility, according to Department of Foreign Affairs acting Secretary Albert del Rosario.
Del Rosario further said that the Philippine government is prepared to shoulder the travel of expenses of the 300,000 Filipinos in Japan, 200,000 of whom live in the capital city in the event the alert were raised to 3.
A bus sent by the Embassy carrying 42 Filipinos from Sendai arrived in Tokyo on Wednesday. They are seeking refuge at a Catholic Church in Kichijogi.
Fr. Resty Ogsimer from the Franciscan Chapel Center in Tokyo, posted these messages on Facebook, "With your prayers and support, the 43 evacuees, 23 adults and 20 children are all okay. Their meals are settled until dinner tomorrow. Thanks to all who have volunteered and shared their resources and time. In the meantime, we need volunteers who speak Japanese who can entertain and play with the children. Thank you!
"For those who are willing to donate money via Postal Services, here is the account: Post Office Account, Number: 00150-5-120640, Catholic Tokyo International Center Sanjokai- Jishin. This is free of charge. Any amount will do as long as it is from the heart. Thank you!" from Fr. Ogsimer.
Watch the attached YouTube video showing the negotiations between Filipino residents in Sendai and Embassy officials in the thick of the action.